Provider Demographics
NPI:1508584822
Name:RAGAN, JONATHAN NORRIS (PD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NORRIS
Last Name:RAGAN
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 W SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4959
Mailing Address - Country:US
Mailing Address - Phone:479-756-3232
Mailing Address - Fax:479-756-1217
Practice Address - Street 1:3819 W SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4959
Practice Address - Country:US
Practice Address - Phone:479-756-3232
Practice Address - Fax:479-756-1217
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163497407Medicaid